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Substance-focused
initiatives not only way schools help prevent risky substance use

Surveys in the West Midlands indicate that schools which engage pupils in
their school and their education also protect them against risky forms of
substance use, offering a way to prevent substance misuse by focusing on core
educational and social virtues.

FINDINGS
Two of the reports derived from the 1995–6 West Midlands Young People's
Lifestyle Survey of nearly 26,000 pupils in grades 7, 9 and 11 (ages 11 to 16)
in 166 secondary schools who completed an anonymous health and lifestyle
questionnaire.
The latest
was concerned with drinking and use of illegal drugs.1
For the purposes of the study, pupils who admitted drinking at least 10 UK units
of alcohol (80g) a week were designated heavy drinkers. Since adolescent
drinkers normally consume once or twice a week, they might also be considered
'binge' drinkers. Grade 7 pupils (aged 11–12) who drank alcohol at least monthly
were considered early initiators. The survey also asked about regular use of one
or more of seven illegal drugs, including cannabis.

A
third report from the same area followed up roughly 7000 pupils initially
aged 13–14 for two years.5 The data derived from
52 schools evaluating an anti-smoking intervention. That was ineffective, but
school culture reflected by the added value index seemed to curb the uptake of
smoking and to restrain consumption among pupils who started the study as
smokers. All else being equal, compared to a school at the bottom of the added
value scale, by the end of the study a school towards the top would have 7%
fewer pupils (18% versus 25%) who smoked at least weekly.

IN CONTEXT
These findings echo an earlier
report from the Glasgow area where over 2000 pupils were followed up from
1994 when they were ending primary school (age 11) to their last year of
compulsory schooling (age 15) in 43 randomly selected secondary schools.6
Differences between schools in the proportions of pupils at age 13 or 15 who
regularly drank, were smokers, or had used illegal drugs, could not be accounted
for by a battery of pupil, family and social background measures (including
substance-related experiences at primary school and parental smoking and
drinking) nor by the neighbourhoods the schools drew their pupils from. It was,
it seemed, something about the schools which produced the differences. For all
three forms of substance use and at both ages, the school's influence was at
least partly accounted for by the degree to which its pupils felt disengaged
from school and from education and by how many teachers they felt they got along
with.

In both areas the greatest influences on levels of substance use in a school
were usually the social backgrounds and characteristics of its pupils. Still it
seemed that schools could make a worthwhile contribution to mitigating or
promoting these influences simply by being good schools which engaged and forged
positive relationships with their pupils. Also in both, the relative influence
of the school diminished as pupils aged. This might have been an artefact of
what was measured. Though worryingly atypical at an earlier age, by
school-leaving age the assessed substance use patterns would have been more
normative. Had the reports been able to titrate their measures to pupils' ages,
they might have found that the school retained its influence.

Despite attempts to eliminate alternative explanations, the major doubt over
the reports is whether school culture reflected in the commitment of the pupils
was actually instrumental in determining levels of atypical substance use. If it
was, then changing the culture to bolster commitment can be expected to curb
use. On the other hand, it could be (for example) that good schools attract
families whose children are less at risk, or that both culture and substance use
reflect some other factor, such as unmeasured quirks of the neighbourhood. In
these cases, enhancing school culture would not impact on substance use.

Doubts are allayed by the consistency of the findings and by their
compatibility with closely allied findings on pupils' 'connectedness' to school
– the sense of being part of a valued school community
click here for details. Mainly US studies have linked higher connectedness
to healthy development, including avoidance of early and risky substance use.7
Connectedness is higher in warm and supportive schools with a caring, inclusive
ethos, which emphasise prosocial values, encourage cooperation, show concern for
pupils as individuals, allow pupils to participate in decision-making and offer
extracurricular activities. Attempts to foster pupil development and school
bonding by creating this kind of climate have sometimes worked, but some schools
have been unable to take these interventions on board.

A few studies have also directly tested whether such efforts reduce substance
use. The results have at best been inconclusively promising. This could be
because the greatest impact is on particularly deviant forms of drug use,
frowned on by most pupils as well as by the school, rather than age-typical
substance use experimentation. Also, the improvement levers open to researchers
fall far short of those available to authorities which can replace staff, inject
resources and mandate compliance. This may be partly why findings are muddied by
a suspicion that schools able to implement school climate interventions were
already on a positive trajectory.

PRACTICE
IMPLICATIONS Because they are all-pervasive, school culture improvements
might justify themselves on a multiplicity of grounds including academic
achievement and crime prevention as well as substance use, and may seem a better
bet for schools than diverting resources to dedicated drug prevention activities
with their patchy track record. The
evidence is strong that schools which (as in the featured studies) develop
supportive, engaging and inclusive cultures, and which offer opportunities to
participate in school decision-making and extracurricular activities, create
better outcomes across many domains, including non-normative substance use.7
As well as facilitating bonding, such schools are likely to make it easier for
pupils to seek and receive the support they need. However, these studies
document the impacts of normal school development processes. Doubts remain over
whether an add-on intervention to improve school culture can be implemented and
effective unless these processes have already created fertile ground. The
lessons seem to be to attend to the basics through school management, training,
pastoral and administrative procedures which foster and demonstrate a caring,
cooperative and participative ethos and concern for pupils as individuals, then
perhaps to seek to optimise these virtues through targeted interventions.

Thanks for their comments on this entry in draft to
Patrick West and Lyndal Bond of the MRC Social & Public Health Sciences Unit and
Chris Bonell and Adam Fletcher of the London School of Hygiene & Tropical
Medicine. Commentators bear no responsibility for the text including the
interpretations and any remaining errors.

2 Supporting its validity as
an index of lack of commitment to the school, the truancy index co-varied with
two other such indices: the rate of authorised absence and the proportion of
pupils who failed to secure qualifications virtually all could achieve had they
tried.4

3 The only other
statistically significant relationship in the adjusted analysis was between good
exam results and fewer pupils engaging in heavy drinking.